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        <p>这是中华口腔医学会的课程，得是会员才能看。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0197-basictreatment/01.png"><br><strong>总论:规范化的牙周病基础治疗</strong><br>诊断明确，治疗以检查为依u据，治疗到位而不越位。<br>治疗方法有效，有循证医学依据<br>安全:规避风险，权衡利弊<br>有长期疗效保持目标<br>患者知情<br>多种目标<br>牙周病基础治疗的内容:<br>①拔除治疗无望或影响修复的患牙<br>②口腔卫生宣教<br>③洁治，刮治，根面平整。<br>④去除菌斑滞留因素<br>充填物悬突<br>冠边缘不密合<br>贴面边缘不移行<br>带环托槽靠近龈缘<br>食物嵌塞<br>⑤咬合调整<br>⑥药物治疗:没有特效药<br>⑦与牙周病相关的全身疾病的治疗<br>⑧纠正不良的生活习惯。<br>牙周基础治疗的重要性<br>①病因治疗<br>②牙周治疗的基础环节，第一步<br>③可以成功治疗大部分牙周病<br>④牙周手术治疗和其它治疗的基础<br>⑤OHI和龈上洁治也是预防的重要手段<br>⑥全科医生应该掌握的技术<br><strong>口腔卫生宣教</strong><br>目的是让受众知信行。<br>进行口腔卫生宣教的原因:<br>菌斑是牙周病的始动因素，菌斑不断沉积形成牙石有个过程，刷牙等机械方法是清除菌斑最有效和安全的手段。<br>有效的菌斑控制是牙周治疗维持长期疗效的保证。<br>技巧:科学性、直观性、针对性、趣味性、反复宣教、正反两方面、注重宣教对象的心理。<br>宣教内容:介绍口腔知识，剖析错误观念，解释治疗的意义和问题，保健用品的选择和使用。<br><strong>规范化的牙周病基础治疗:龈上洁治、龈下刮治</strong><br>目的:①彻底清除病源刺激物;②消除炎症;③清除影响组织愈合的障碍。<br>慢性牙周炎即是一个骨肉分离的过程。<br>目标:洁净，组织损伤少，舒适(清洁里子，保护面子)。<br>牙石是钙化的菌斑，表面覆盖菌斑，牙石本身并不引起炎症，牙石的多孔结构可吸收大量的细菌毒素，对牙周有一定的机械刺激、妨碍口腔卫生措施的实施。<br>龈下牙石的特点:呈褐色或黑色;体积薄而硬;与根面的附着比龈上牙石更牢固。<br>难点:牙石与牙面结合紧密;牙石与牙齿结构相似，机械治疗最安全;龈下牙石-龈上牙石:龈下2mm，分次洁治;隐匿(邻面，龈下)，盲刮(牙周治疗是良心活);牙周袋空间狭窄。<br><strong>基础治疗的器械选择</strong><br>超声器械，有压电式和磁致伸缩式两种。<br>龈上洁治一般用超声，降低劳动强度。<br>工作原理:机械振动/摩擦作用;水分子的空穴作用。<br>喷水的作用:降温;空穴作用;冲洗作用;播散细菌。<br>功率大，效率高，不适感增加，根面划痕。工作尖尖端磨损，影响功率。<br>操作要点:<br>①选择好适应症，3%过氧化氢溶液含漱。<br>②确定工作头的类型(龈上，龈下)，检查工作端长度。<br>③调整功率和水量。<br>④改良握笔式握持。<br>⑤工作端侧缘与牙面接触，不能垂直于牙面。<br>龈下刮治:超声+手工<br>器械选择:牙位，锐利度，强度(宽度)。<br>常用手工刮治器:<br>5/6:前牙<br>7/8:后牙颊舌侧<br>11/12:后牙近中邻面<br>13/14:后牙远中邻面<br>器械锐利度检查:握持器械对光，如果能看到反光则器械是锐利的。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0197-basictreatment/02.png"><br>刮治器尖端是圆钝的，洁治器尖端是尖的。<br>确认工作刃:器械柄直立，尖端对向自己，较低的一侧为工作刃。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0197-basictreatment/03.png"><br>操作要点<br>稳、准、狠:握持、支点、器械角度、用力方式(用腕力)。<br>减少组织损伤的措施:进入角度、支点不稳、牙龈支点、反复进入牙周袋、邻面拐入。<br>龈下刮治的指征:到位不越位。龈上洁治一周后牙周探诊，如有4mm以上牙周袋需要进行刮治。<br>龈下刮治评价:尖探针探诊，无跳跃感，在玻璃表面划过。<br><strong>牙周治疗的体位</strong><br>体位选择:三舒适原则<br>医生舒适，患者舒适，别人看着舒适。<br>避免频繁更换体位。<br>医生的位置:8点到2点。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0197-basictreatment/04.png"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0197-basictreatment/05.png"><br><strong>患者风险规避</strong><br>存在凝血功能障碍者;服用抗凝剂患者;白血病患者;糖尿病未控制者;心脏支架、关节置换、风心病;传染病患者;心脏起搏器患者。<br>交叉感染的防范。<br>牙周基础治疗可能存在的问题:牙缝变大、牙齿敏感、充填物脱落、出血、菌血症:低烧、器械折断、牙龈损伤、牙周脓肿。</p>
<p>我发文章的四个地方，欢迎大家在朋友圈等地方分享，欢迎点“在看”。<br>我的个人博客地址：<a href="https://zwdnet.github.io/">https://zwdnet.github.io</a><br>我的知乎文章地址： <a target="_blank" rel="noopener" href="https://www.zhihu.com/people/zhao-you-min/posts">https://www.zhihu.com/people/zhao-you-min/posts</a><br>我的博客园博客地址： <a target="_blank" rel="noopener" href="https://www.cnblogs.com/zwdnet/">https://www.cnblogs.com/zwdnet/</a><br>我的微信个人订阅号：赵瑜敏的口腔医学学习园地</p>
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